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Khandavilli SD, Cole-Healy Z, Douglas A. The 'Manchester' method of minimal access fixation of the zygomatic arch in zygomatic complex fractures: a case series. Br J Oral Maxillofac Surg 2024; 62:493-497. [PMID: 38782636 DOI: 10.1016/j.bjoms.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
We have introduced a minimally invasive approach for the fixation of the zygomatic arch during the surgical management of zygomatic complex fractures. Access for this technique is provided by a preauricular approach and eyelid incisions with the addition of transcutaneous stab incisions overlying the arch. These stab incisions allow transcutaneous drilling and screw placement through a size CH 20 (5.0 mm) paediatric nasopharyngeal airway (NPA). We present a case series of seven patients. In all patients the arch component was successfully reduced and fixed, and no intraoperative or postoperative complications were observed. The use of an NPA is novel. It functions as a flexible self-irrigating sleeve and protects the skin from mechanical and thermal damage. The technique uses readily available equipment, is easy to learn, and simplifies surgery to the zygomatic arch.
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Affiliation(s)
- Sunil Dixit Khandavilli
- Oral and Maxillofacial Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, United Kingdom
| | - Zachary Cole-Healy
- Oral and Maxillofacial Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, United Kingdom.
| | - Andrew Douglas
- Oral and Maxillofacial Surgery, James Cook University Hospital, Marton Rd, Middlesbrough, TS4 3BW, United Kingdom
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Gong J, Zhao R, Zhang W, Li J, Yuan Z, Ma D. Role of Intraoperative Imaging in Improving Closed Reduction of Zygomatic Arch Fractures: A Systematic Review and Meta-analysis. J Oral Maxillofac Surg 2023; 81:1504-1516. [PMID: 37775088 DOI: 10.1016/j.joms.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/08/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE The use of intraoperative imaging (IOI) to improve the reduction adequacy of zygomatic arch (ZMA) fractures has been reported, but few systematic reviews have examined this topic. The aim of this review was to investigate and compare the value of IOI with conventional methods without IOI (N-IOI) for the closed reduction of ZMA fractures. METHODS Electronic retrieval of MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and citation search until December 2, 2022, was used to identify controlled clinical trials that employed IOI for improving adequacy in closed reduction of ZMA fractures. The predictor variable was the use of IOI-yes/no (IOI vs N-IOI). The covariates included imaging technique (ultrasound, C-arm, and cone beam computed tomography) and ZMA fracture type (M-shape fracture, mechanistic force in 1 direction; variable fracture, mechanistic force in 2 directions). The primary outcome variables were the reduction adequacy of ZMA fractures (the remaining cortical step and dislocation angle) compared with the ideal mirrored position. Weighted or mean differences, risk ratios, and corresponding 95% confidence intervals were calculated, where P >.05 and I2<50% fixed effect model was adopted, and a vice versa random effect model was adopted. RESULTS A total of 1250 studies were identified, of which 6 studies with 259 participants were included. The meta-analysis results indicated that compared with N-IOI, IOI yielded fewer cortical steps (-1.76 [-2.42, 1.10], P <.00001, fixed model) and dislocation angles (-5.60 [-8.08, 3.12], P<.00001, fixed model) in patients with variable ZMA fractures, while no significant difference was detected in the M-shape ZMA fracture (-0.72, [-2.93, 1.48], P = .52; -1.48, [-3.51, 0.55], P = .15). Although there was no significant difference in postoperative correction (0.35, [0.06, 2.01] P = .24, fixed model), all secondary revision cases occurred in the N-IOI group. Descriptive analysis showed that IOI yielded better symmetry and appearance satisfaction. CONCLUSION IOI improved the adequacy of the procedure and led to a better postoperative appearance, especially for patients with variable ZMA fractures. Furthermore, the use of IOI avoided the risk of secondary surgery. In future studies, researchers should standardize the scale and outcomes to facilitate the intuitive evaluation of reduction adequacy.
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Affiliation(s)
- Jiaming Gong
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Ruimin Zhao
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Wenlong Zhang
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; School of Stomatology, Lanzhou University, Lanzhou City, PR China
| | - Jianxue Li
- Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China
| | - Zhenfei Yuan
- Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Dongyang Ma
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; School of Stomatology, Lanzhou University, Lanzhou City, PR China.
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Design and Use of a Pair of Computer-Designed Surgical Templates in Reduction of a Comminuted Zygomatic Arch Fracture. J Craniofac Surg 2022; 33:2606-2608. [DOI: 10.1097/scs.0000000000008664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
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Rao S, Pandey S, Rao S. Rhytidectomy approach for treatment of zygomatic arch fractures. BMJ Case Rep 2021; 14:14/1/e238972. [PMID: 33495186 PMCID: PMC7839846 DOI: 10.1136/bcr-2020-238972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Comminuted zygomatic arch fractures are a challenge to manage without complete exposure owing to their instability. The presence of facial nerve branches near the bone often means that these fractures are often treated by closed methods or left untreated. The disadvantages of such comminuted fracture left untreated cannot be overemphasised. Hence, there is a need of a surgical approach for exposure and fixation of such fractures without limitation of facial nerve injury. We propose and report a case of malunited comminuted fracture of zygomatic arch using facelift approach.
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Affiliation(s)
- Santhosh Rao
- Dentistry—Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Tatibandh, India
| | - Sameer Pandey
- Dentistry—Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Tatibandh, India,Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sruthi Rao
- Oral & Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
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Panneerselvam E, Balasubramanian S, Kempraj J, Babu VR, Raja VBKK. Management of Zygomatic Arch Fractures by Intraoral Open Reduction and Transbuccal Fixation: A Technical Note. Craniomaxillofac Trauma Reconstr 2020; 13:130-132. [PMID: 32642044 DOI: 10.1177/1943387520911866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fractures of the zygomatic arch are common due to its anatomical prominence. The post-traumatic restoration of the arch form is important to maintain the midfacial symmetry and anteroposterior projection of the face. Open reduction and internal fixation (ORIF) of fractured arch is indicated in specific clinical presentations. The traditional methods of ORIF of zygomatic arch fractures require cutaneous incisions, which are associated with complications such as scarring and facial nerve injury. This article presents a simple technique of "intraoral reduction and transbuccal fixation" of the arch that negates the problems associated with the conventional approaches to ORIF.
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Affiliation(s)
- Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
| | - Sasikala Balasubramanian
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
| | - Jaghandeep Kempraj
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
| | - Vijitha Ravindira Babu
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
| | - V B Krishna Kumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
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Akdag O, Guray Evin S, Isik C, Tosun Z. Endoscopic-Assisted Zygomatic Arch Fracture Repair With a Preauricular Approach. Plast Surg (Oakv) 2019; 27:107-111. [PMID: 31106166 DOI: 10.1177/2292550318800327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Because of numerous negative sequelae with open techniques, endoscopic techniques are beginning to be widely used for maxillofacial fractures. Many endoscopic approaches for this area have been described according to several dissection plans and incisions. The aim of the present study was to report a new surgical incision and dissection method for zygomatic arch fracture that aims at reducing the complication rate of previously defined techniques. Material and Methods The authors operated on 8 patients with a new endoscopic-assisted surgical technique. This study focused on evaluating the complication rate and surgical comfort of these patients. Results Of the 8 patients, the plate was palpable in the zygomatic arch in one. No complications occurred due to this technique during the 1-year follow-up. Symmetrical facial contour and inconspicuous scars were obtained in all patients. Average operative time was 3 hours; hospitalization time was 1.6 days. Conclusion This study demonstrates that an endoscopic-assisted surgical approach with a preauricular mini-incision can be safely performed in isolated multifragment zygomatic arch fractures. Using individually designed plates improved our results. This technique is easy to apply, its cosmetic results are good, and its complication rate is low.
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Affiliation(s)
- Osman Akdag
- Department of Plastic Surgery, Selcuk University, Konya, Turkey
| | | | - Cemil Isik
- Department of Plastic Surgery, Selcuk University, Konya, Turkey
| | - Zekeriya Tosun
- Department of Plastic Surgery, Selcuk University, Konya, Turkey
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Intraoperative Ultrasound Control of Zygomatic Arch Fractures: Does Additional Imaging Improve Reduction Quality? J Oral Maxillofac Surg 2019; 77:769-776. [DOI: 10.1016/j.joms.2018.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023]
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Kim H, Yoon J, Lee BI. "Radiological morphometric analysis of the zygomatic arch: Application of osteosynthesis on the upper arch border for rigid fixation". J Plast Reconstr Aesthet Surg 2018; 72:831-841. [PMID: 30503372 DOI: 10.1016/j.bjps.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was designed to introduce a novel method of applying osteosynthetic materials to the upper zygomatic arch border for fracture fixation through a temporal incision, and analyze the radiologic morphometric dimensions of the arch to verify its validity. METHODS Radiological morphometry was analyzed in 51 adult patients with unilateral isolated zygomatic arch fractures. Frequent fracture sites, sites of minimal thickness and height, and their correlation were evaluated, as were the locations and dimensions of fixation vantage points. The novel surgical method based on the results was implemented in 17 clinical cases. RESULTS Frequent fracture sites, occurring 4.40, 16.47 and 30.48 mm posterior to the arch origin, did not correlate to sites of minimal height and thickness. Arch minimal thickness and height locations were 12.23 and 27.09 mm behind its origin, respectively. Fixation vantage point dimensions varied from point to point, with upper thickness ranging from 1.67 to 4.86 mm and mid-portion thickness ranging from 2.06 to 7.36 mm, and height ranging from 8.99 to 22.53 mm. Arch vertical axis inclination ranged from 6.51° to 16.47°, which increased as the arch stretches posteriorly. These results suggested the use of 1.5 mm-wide plates and 1 mm-diameter screws with 6-8 mm length. Patients received surgery based on these morphometry results for satisfactory stabilization. CONCLUSIONS This study introduces a new method for open reduction and internal fixation of arch fractures, with morphometric analysis of the arch verifying the validity of tangential plate application to the upper border.
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Affiliation(s)
- Hyonsurk Kim
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31116, Republic of Korea
| | - Jeongmin Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Byung-Il Lee
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
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Buller J, Zirk E, Kreppel M, Grandoch A, Maus V, Zirk M, Zöller JE. Radiomorphometric analysis of isolated zygomatic arch fractures: A comparison of classifications and reduction outcomes. J Craniomaxillofac Surg 2018; 46:1252-1257. [PMID: 29884318 DOI: 10.1016/j.jcms.2018.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022] Open
Abstract
PURPOSE Although different proposals have been made to categorize isolated zygomatic arch fractures (ZAF), an investigation about fracture type and clinical outcome has not been published. In this study, we analyzed the geometric fracture morphology in isolated ZAF and provide a survey of reduction outcomes in accordance with 4 independent classifications. MATERIALS AND METHODS Geometric measurements were performed in radiologic images of 94 patients with isolated ZAF, which were consecutively treated by closed reduction over transbuccal approach. Fracture types were allocated to the classifications of Rowe and Williams, Honig and Merten, Yamamoto et al., and Ozyazgan et al. The odds of achieving a satisfactory outcome were calculated for all categories. RESULTS Wide preoperative dislocation angles of more than 22° presented in M-type fractures (77.1%) more frequently compared to 2 fragments without the M-shape (33.3%) and one fragment (14.8%, p < 0.001). Favorable reduction outcome was significantly higher for M-shaped fractures than for differently configured fractures (83.3% vs. 30.4%, odds ratio 11.43, confidence interval 4.27-30.61). The rate of reduction in 100%-75% was most frequent for the Honig and Merten type I as well as Ozyazgan type IBV (both 85.4%, p < 0.001) and Yamamoto type II (84.2%, p < 0.001). CONCLUSION The classifications of Honig and Merten, Yamamoto et al., and Ozyazgan were quite applicable, and subgroups showed significant increments in reduction outcome. Our analysis emphasizes that the differentiation of two clinical relevant groups, M-shaped and variable arch fractures, is feasible to manage and efficient to determine the odds of reduction outcome.
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Affiliation(s)
- Johannes Buller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Elisa Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany; Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
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Pedemonte C, Sáez F, Vargas I, González E, Canales M, Lazo D, Pérez H. C-arm as intraoperative control in reduction of isolated zygomatic arch fractures: a randomized clinical trial. Oral Maxillofac Surg 2016; 20:79-83. [PMID: 26546376 DOI: 10.1007/s10006-015-0531-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Isolated zygomatic arch fractures (IZAFs) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. METHODS Our hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009 and 2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into two groups: 25 patients were in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm, and 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. RESULTS The results did not reveal significant differences between both groups (p = 0.5). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. CONCLUSIONS Despite the fact that the results are not statistically significant (p = 0.5), the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction.
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Affiliation(s)
- Christian Pedemonte
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile.
| | - Felipe Sáez
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Ilich Vargas
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Edgardo González
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Marco Canales
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Diego Lazo
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Hernán Pérez
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Badillo O, Osben R, Vidal C, Duarte V. Design and use of an instrument for video-assisted surgical treatment of unstable fractures of the zygomatic arch: the Z instrument. Br J Oral Maxillofac Surg 2015; 53:767-8. [PMID: 26009148 DOI: 10.1016/j.bjoms.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 05/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Oscar Badillo
- Department of Oral and Maxillofacial Surgery Hospital Carlos Van Buren, Valparaíso, Chile, San Ignacio 725, Valparaíso, Chile
| | - Roberto Osben
- Department of Oral and Maxillofacial Surgery Hospital Carlos Van Buren, Valparaíso, Chile, San Ignacio 725, Valparaíso, Chile
| | - Constanza Vidal
- Department of Oral and Maxillofacial Surgery Hospital Carlos Van Buren, Valparaíso, Chile, San Ignacio 725, Valparaíso, Chile
| | - Valentina Duarte
- Department of Oral and Maxillofacial Surgery Hospital Carlos Van Buren, Valparaíso, Chile, San Ignacio 725, Valparaíso, Chile; Pontificia Universidad Católica de Valparaíso, Av. Brasil 2950, Valparaíso, Chile.
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Abstract
The zygomaticomaxillary complex (ZMC) has important aesthetic, structural, and functional roles that need to be preserved and/or restored during treatment of facial fractures. Surgical treatment of ZMC fractures is indicated when there is displacement of the bony fragments, and open reduction and internal fixation is the treatment of choice in cases of comminution or fracture instability. The surgical approaches used for fracture reduction as well as the type, number, and location of the fixation will be determined by the pattern of the fracture and the surgeon's preference. This article discusses the main points of the management of ZMC fractures.
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Thangavelu K, Ganesh NS, Kumar JA, Sabitha S, Nikil. Evaluation of the lateral orbital approach in management of zygomatic bone fractures. J Nat Sci Biol Med 2013; 4:117-21. [PMID: 23633846 PMCID: PMC3633260 DOI: 10.4103/0976-9668.107271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Zygomatic maxillary fractures, also known as tripod fractures, are usually the result of a direct blow to the body of the zygoma. Tripod fracture consists of (a) zygomatic arch fracture, (b) fracture of the lateral orbital wall, and (c) fracture of the inferior orbital floor. The purpose of this study is to evaluate the functional and esthetic outcome following this lateral orbital approach in the management of zygoma fracture. This study was carried out in VMS Dental College, Salem, and in a private hospital. This study was based on the experience gained from a retrospective study of the 30 lateral orbital approaches that were used in 30 patients with fractures of the zygomatic complex, which were conducted for a period of 8 years between January 2003 and January 2011. In the retrospective study, all the 30 patients were able to open the mouth completely; eyeball movements were normal; esthetically, all patients appeared normal. There were no sinusitis or visual problems in any of the studied patients. We conclude that the lateral orbital approach is an ideal option in reduction and treatment of zygomatic bone and arch fractures.
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Affiliation(s)
- K Thangavelu
- Department of Oral Surgery, V. M. S. Dental College, Salem, Tamil Nadu, India
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Lee EI, Mohan K, Koshy JC, Hollier LH. Optimizing the surgical management of zygomaticomaxillary complex fractures. Semin Plast Surg 2012; 24:389-97. [PMID: 22550463 DOI: 10.1055/s-0030-1269768] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zygomaticomaxillary complex (ZMC) fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. Like other facial fractures, the optimal management of operative ZMC fractures requires anatomic reduction of all fractures followed by rigid internal fixation. However, surgical treatment of these fractures can be quite challenging with the potential for high rates of complications. The goal of this article is to provide an overview of ZMC fractures and discuss treatment options, with an emphasis on providing surgical pearls to optimize outcomes.
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Affiliation(s)
- Edward I Lee
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Xie L, Zhang D, Lu MMX, Gao BML. Minimally invasive endoscopic-assisted resection of benign tumors in the accessory parotid gland: 5 case studies. Head Neck 2011; 34:1194-7. [DOI: 10.1002/hed.21751] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 12/23/2010] [Accepted: 01/24/2011] [Indexed: 11/06/2022] Open
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